What a difference a clip makes! Analysis of boost volume definition in radiation therapy for conservative breast surgery

Publication date: Available online 26 June 2018
Source:European Journal of Surgical Oncology
Author(s): Thiago Brasileiro de Freitas, Kennya Medeiros Lopes de Barros Lima, Heloísa de Andrade Carvalho, Patricia de Azevedo Marques, Fabio Teixeira Belfort Mattos, Alexandre Siqueira Franco Fonseca, Alexandre Mendonça Munhoz, José Roberto Filassi, Silvia R. Stuart, Gustavo Nader Marta
Purpose/Objective(s)To evaluate the role of surgical clips placement in the definition of boost treatment volume.Materials/MethodsClinical Target Volumes (CTV) were defined as: CTV Breast, CTV Quadrant (based on physical exam and pre-surgical images), CTV Boost, defined by clip plus margin (1 cm for 2 or more clips and 2 cm for 1 clip only) plus radiological changes, CTV NT (normal tissue), defined by CTV Quadrant minus CTV Boost and CTV MISS (CTV that would be outside the treatment volume), defined by CTV Boost minus CTV Quadrant.ResultsA total of 247 patients were included. Upper lateral quadrant was the most common clinical location (47.3%). The median number of clips used was three. The mean volumes were: CTV Breast:982.52cc, CTV Boost:36.59cc, CTV Quadrant:285.07cc, CTV NT:210.1cc and CTV MISS:13.57cc. Only 50.6% (125) of the patients presented the CTV Boost completely inside the CTV Quadrant and in 47.3% (117), partially inside. Among patients with any CTV MISS, 80.3% (98) had 10% or more of CTV Boost outside the treatment volume. Regarding CTV MISS, there were no statistically significant differences between the groups with 1 clip versus 2 or more clips, nor between patients with or without reconstructive surgery. In average, the CTV Boost was 87% smaller than the CTV Quadrant. The whole quadrant irradiation would lead to unnecessary irradiation of 26% of normal breast tissue.ConclusionSurgical bed clipping is up most important in the definition of the boost volume irradiation to ensure precision minimizing geographical miss and optimizing surrounding normal tissue sparing.



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